S8 L2 Lower GI Malignancy

Question 1

Lower GI Malignancy
- Three key symptoms

Answer 1

• Obstruction
• Per Rectum (PR) bleeding
• Change in bowel habit

Often need to look at these symptoms together

Question 2

1st Main Symptom: Obstruction

• What is this?
• General symptoms
• Large bowel (lower in GI tract) vs small bowel (higher in GI tract) symptoms, and explain the differences in symptoms

Answer 2

Small bowel - Nausea/vomiting
If malignancy is higher up, pressure will build up backwards.
More likely to present with: Vomiting

Large bowel - Constipation (absolute)
• Less likely to present with vomiting as need significant build up to cause this
• Constipation: ‘Absolute constipation’ (not passing any feacal matter or wind) must ask a patient if they are passing wind, as at risk of bowel perforation (could lead to peritonitis and then sepsis

Question 3

Differentials for Obstruction

Answer 3

Question 4

Red Flags - Obstruction

Answer 4

1. Unintential weight loss
2. Unexplained abdominal pain (i.e. not being able to find a reason for the pain)

Question 5

2nd Main Symptom: PR Bleeding

• Differntial Diagnosis
• Nature of bleeding

Answer 5

Question 6

PR Bleeding
- Red flags

Answer 6

Question 7

3rd Main Symptom: Change in bowel habit

• Type of changes that can occur…
• Differentials for Change in Bowel habit
• Red flags

Answer 7

Many benign causes of change in bowel habit!
• Age dependent
• Iron deficiency anaemia
• Unexplained weight loss
• PR blood loss

Question 8

Large Bowel Cancer

• Main type of large bowel cancer
• Prevalence
• Risk factors for it
• Screening - how is this done? which group of people? who can have more reguar screens?

Answer 8

Question 9

Transistion from Polyps to Adenocarcinoma…

Answer 9

Question 10

Large Bowel cancer:
Right sided colon cancer vs Left sided colon cancer
- Signs and symptoms
- Differences in signs and symptoms
- Prognosis differences…

Answer 10

Question 11

What may a left sided colon cancer look like with barium enema?

Answer 11

Question 12

Small Bowel Cancer

• Prevalance?
• Different types…
• Risk factors…
• Symptoms…

Answer 12

Question 13

General Management:
- Diagnosis (3 main types)

Answer 13

Question 14

TNM staging

Answer 14

Question 15

Duke’s Staging

Answer 15

Question 16

Treatment

Answer 16

Question 17

Quandrants of the abdomen and which pathologies causes pain in which areas…

Answer 17

Question 18

GW:

1. Name of the pain associated with gallstones
2. Which cells produce CCK?
3. 2 Potential complications of stone in proximal CBD?
4. 2 Potential complications of stones in distal CBD
5. Order of liver issues that occur due to chronic alcohol intake
6. Which part of the stomach is the most common loication of gastric ulcers?

Answer 18

1. Bilary colic
2. I cells
3. Gall bladder perforation, Post-hepatic jaundice
4. Acute pancreatitis, Post-herpatic jaundice
5. Fatty liver (leads to enlarged liver)
   Liver cirrhosis (leads to small liver)
6. Lesser curve of the stomach